Over the years there has been much back and forth about how abortion affects a woman's mental health. From the feminism of the 1960s to the current "safe, legal and rare", we rarely hear about abortion without it being tied to a woman's state of mind. Back in the 1960s, women needed the right to abortion to get rid of their traditional role as mother and caretaker; today we hear countless politicians talk about how hard it is to make the decision to have an abortion.

Recently, mandatory counseling laws have been enacted to expand informed consent to, often, uninformed consent - telling women that abortion causes breast cancer or that she is killing a separate human being. Some of these mandatory counseling laws include provisions about how depressed a woman will be after an abortion (not how depressed she may be...she may also feel elated).

"The best scientific evidence published indicates that among adult
women who have an unplanned pregnancy, the relative risk of mental
health problems is no greater if they have a single elective
first-trimester abortion or deliver that pregnancy," said Brenda Major,
PhD, chair of the task force. "The evidence regarding the relative
mental health risks associated with multiple abortions is more
uncertain."

The task force found that some studies indicate that some women do
experience sadness, grief and feelings of loss following an abortion,
and some may experience "clinically significant disorders, including
depression and anxiety." However, the task force found "no evidence
sufficient to support the claim that an observed association between
abortion history and mental health was caused by the abortion per se,
as opposed to other factors."

The report noted that other co-occurring risk factors, including
poverty, prior exposure to violence, a history of emotional problems, a
history of drug or alcohol use, and prior unwanted births predispose
women to experience both unwanted pregnancies and mental health
problems after a pregnancy, irrespective of how the pregnancy is
resolved. Failures to control for these co-occurring risk factors, the
task force noted, may lead to reports of associations between abortion
history and mental health problems that are misleading.

The report noted that women have abortions for many different reasons
and within different personal, social, economic and cultural
circumstances, all of which could affect a woman's mental state
following abortion. "Consequently," the task force wrote, "global
statements about the psychological impact of abortion can be
misleading."

According to the report, women terminating a wanted pregnancy, who
perceived pressure from others to terminate their pregnancy, or who
perceived a need to keep their abortion secret from their family and
friends because of stigma associated with abortion, were more likely to
experience negative psychological reactions following abortion.

Of course there are lots of women who regret having an abortion, some who become dedicated anti-choice crusaders, like Leslee Unruh. But that doesn't mean that abortion is the wrong choice for everyone and will permanently scare the psyche of every woman (or that only people who have had multiple abortions can support a woman candidate). In fact, if a woman freely chooses abortion and isn't judged for it, it sounds like she'll be much better off. So yes, the pro-choice movement should be involved in post-abortion counseling, but for my money, I'd prefer pre-abortion counseling. This counseling could not only make sure that a woman understands the medical procedure she's about to have, but make sure that she's not being coerced, that she has a support system, that if she has drug, alcohol or violence problems in her life that she is referred for help. These are the efforts we can make if we're interested in improving mental health for women having abortions.

TRICARE, the insurance for the uniformed services, has released a proposed rule today that would change coverage for the insurance system. The proposed rule includes covering exams for sexual assault or domestic violence. While the costs of these are often shared by the private co-insurance, some victims of assault were getting billed for the exams. The coverage sheet reads:

However, there is a dual
purpose of the examination process. One purpose is to address the needs of the
individual disclosing sexual assault, which include evaluating and treating injuries;
conducting prompt examinations; providing support, crisis intervention, and
advocacy; providing prophylaxis against sexually transmitted diseases;
assessing female patients for pregnancy risk and discussing treatment options,
including reproductive health services; and providing follow-up care for
medical and emotional needs. The other purpose is to address justice system
needs. The needs for justice system are: obtaining a history of the assault,
documenting exam findings, properly collecting, handling, and preserving
evidence, and interpreting and analyzing findings (post exam) and subsequently,
presenting findings and providing factual and expert opinion related to the
exam and evidence collection.

I like that the proposed rule addresses both a psychological intervention, and a pursuit of justice.

At the link to the proposed rule are instructions for how to weigh in - please feel free.

Not like you haven't heard it before (especially if you were hanging out with me this weekend) but vasectomies are totally safe. And because this is my blog, I'll tell you my opinion on vasectomies: I'm all for them. No one really wants me to go into it, but here's a quick rundown, from my perspective. Heterosexual women have menstrual cycles, and all that brings. They also bear the brunt of contraception, from what I gather. Further, they are the ones carrying and birthing children, often breastfeeding them. I don't feel it's an outrageous request for men involved with these women to consider vasectomies as fairly painless and totally reversible procedure. The article talks about how men are squeamish about their boy parts, a concern for which I have little sympathy. Somehow testicles became sacred, while women's fallopian tubes, uterii & etc became medically available. It's a procedure that Jamaican men, for example, do not use. You've heard it before.

Speaking of uteri, you may know my obsession with this from my previous posts, but the Picture of the Day from DCist a few days ago was a woman carrying three fetuses in her two uterii. Awesome!

Also, you know how I've been talking about HPV and other cancers, besides cervical, for like, a billion years now? My sister sent me an e-mail today saying that my theory re: anal cancer might be right. (I told her that, um, it's not a theory, it's just not common knowledge) She sent me an article from an Australian paper on oral cancer and HPV. Again, it's not news, but whatever. The Canadian government is now thinking about vaccinating men against HPV too.

Speaking of HPV, y'all know that I have ties to Qiagen, which makes the only HPV test on the market in the US. Anyway, Qiagen is appealing a patent loss which would allow another company to make an HPV test.

Should we talk more about patents? Barr won a patent suit against Bayer for Yasmin. Since this happened months ago, you probably already have a generic pack of Yasmin in your hands if you want one. Bayer stock fell after the news.

I'm really not going to talk about FDA preemption here, but I do want to let you all know what's going on in the courts. Here's the quick and dirty version of the recent Supreme Court case: This guy had a balloon angioplasty, and depending upon which case you read, his doctor either did or did not inflate the balloon properly. In any case, the thing blew up in his heart, almost killing him (but didn't). He sued the manufacturer of the balloon catheter, and in February the Supreme Court ruled that federal FDA law didn't allow for state tort suits, which is how you sue someone when crap like this happens. There is a Supreme Court case coming up testing the same law, but with respect to drugs, not devices. The reason I'm telling you this is that it's J&J's defense for suits regarding Ortho-Evra, the patch. Plus, it's one of the things I've been geeking out about lately.

Have you or anyone you know had a hard time paying for an abortion? A clinic in Iowa wants to know.

We don't have a lot of deaths from abortion anymore, thanks, largely, due to legal abortions and antibiotics. Occasionally, we do, and it's just tragic. Of course, there's more here than just a teenager dies of abortion. She had a legal abortion and bled to death waiting for a transfusion, and, it sounds like it was also an incomplete abortion. Plus, she didn't want to have an abortion, but her boyfriend (and maybe his family) wanted her to.

Okay, I'm going to have to sort through a whole lot of stuff, and figure out how to use this upgraded software.

Did y'all catch last night's Eli Stone (3/27)? So the back story is that the main character is an attorney with a brain aneurysm that's basically inoperable, and he's been having vision of things, including George Michael. So Eli is a bit incredulous when George Michael actually shows up, in the flesh, wanting to hire Eli Stone.

The story this week is that a high school senior, I think, is unhappy with the fact that her school has an abstinence only education program because it gives students inaccurate information. The program includes a school assembly (with, according to the girl, an expert on not doing it). She's talked to principal about it before, but it's the only kind of sex-ed that is federally funded, so the principal can either have no sex-ed, or ab-only. In protest she sneaks into the school's office and plays "I Want Your Sex" over the loudspeaker, for which she is expelled.

George Michael hires Eli Stone to get her reinstated in school, and there's some sort of hearing and it's all fun and first amendment rights and protected speech, and how student speech is limited when it interferes with the learning process and then the girl says something like "that assumes that there's any learning going on" which was amazing. (I don't have the right media player, and I'm not installing it at work, so please correct me if I'm wrong). She says that she was personally affected by the ab-only education because her lab partner got pregnant and then her friend "got gonorrhea...in her mouth."

Then George Michael gives a little speech on how great America is but this ab-only thing is b.s. and then he gives a concert to raise money for a real sex-ed program in that school. Oh, and the school settles and lets her back in and stops taking money for the ab-only program.

By now, I'm sure you've seen that one-quarter of teenage girls have some STI. This includes human papillomavirus
(HPV), chlamydia, herpes simplex virus, and trichomoniasis. This clearly shows a need for comprehensive sex-ed, although some argue that school is not the right place for that kind of learning.

Because, really, one of the obvious questions is: Why aren't teens having protected sex? And their answers vary. It's not just about STIs, but also teen pregnancy, which we know is just not at all good for teens. While people argue about the root causes of teen pregnancy - poor parenting, lack of values, problems with access to contraception - the end result is still dire. Some would go so far as to look at long-term birth control for teens, involuntarily, it appears; certainly, others would like to see a little more of a social stigma for teen pregnancies, rather than seeing these girls fully accepted into society.

There are both a test and two vaccines for HPV. Merck is looking at getting it's vaccine, Gardasil, approved for use by women over 27.

On a related note, a new law has been enacted that makes it a crime to intentionally infect someone with HIV. This is not particularly new, but South Dakota now characterizes this crime as a sex offense.

So really, what's the solution? How do we reduce the incidence of STIs, and keep teen pregnancy down? Expanding the use of Gardasil, and other vaccine products, seems like a good start. Does increasing criminalization of spreading disease help? Do we need more of a stigma on teen pregnancy, or less of one on condoms? What's the answer?

State News:Illinois has a law requiring pharmacists to dispense emergency contraception (Plan B). This law is being challenged in Illinois Supreme Court. According to the article, this may become a procedural issue, one of standing, rather than on on the merits. Nonetheless, it will have ramifications on similar state laws, or on state legislatures considering similar laws.

Kansas is considering some restrictive laws, New Hampshire is looking at mandatory counseling for teens,

Foreign News:Abortion rates in Australia are declining. The abortion debate in Jamaica continues.

That's all I'm going to post for today, and every day I'm going to try to post a bunch more stories that I have bookmarked for y'all.

Sorry it's been so long folks. It's been kind of hectic here, and without internet access at home, and work being busy, well, unfortunately, the blogging kind of falls by the wayside. But, OMG, there is so much going on. I'm sure you know most of it, but let's go over it in any case.

Pop Culture:4 Months, 3 Weeks and 2 Days - an award winning film - was reviewed by the NYT recently. It was a critic's choice film. And, you know, it won the Palm D'Or a while ago. There's still a lot of discussion about Knocked Up/Juno where unplanned pregnancy seems to be something that, well, all works out in the end. Laura Sessions Stepp, who I know many of you don't really like (article topics include hook-up culture and gray rape) wrote an article in the Post pointing out the dangers of being a teen mom.

Maria and I talk about this all the time, because I'm not so keen on the idea of teenagers having kids, and she thinks we need a more supportive community for helping pregnant teens. I don't think it's a great idea, in part because teen pregnancy is the number one indicator of future poverty. This, of course, gets us into teen sex, about which the NYT published an article in January. The article focuses on the emotional impact of sex on teen girls, as well as pregnancy. Good read. Oh, and I'm not getting into this right now, but there was a big to-do over these Denver girls who want maternity leave from high school.

Love:So there was that big TIME Magazine section on love, and it was Valentine's Day yesterday (I got my sweetie these) and so love is in the air. Researchers have shown that people in love don't really check out other potential mates, but they do check out potential rivals. Sadly, sometimes love doesn't work out. When the engagement gets called off there is a developing field of law in who gets what damages, as well as some etiquette on who gets the ring.

Birth Control:There is a new label on the birth control patch. Women who use Ortho-Evra, the patch, are at increased risk of blood clots. The risk is still pretty small, but it's much higher than for women using the pill. Talk to your doctor.

Barr, a maker of generic birth control pills, has filed a patent infringement suit against other pharmaceutical companies over oral contraceptives.

Ireland lowered the condom tax. A 12-pack of condoms costs about E13; they cost about $12 here in the States. I get the impression from the BBC article, by the way, that in some places condoms are free under the country's medical plan.

Washington State has tabled a bill that would require pharmacists to dispense Plan B, or the Morning After Pill. Issues related to conscience clauses loom large in this debate, and it appears that the legislature is going to pitch this over to the court system first. South Dakota, on the other hand, is trying to make sure that pharmacy refusal clauses don't allow pharmacists to refuse to dispense birth control pills.

Sexually Transmitted Infections (Including HPV):There's a journal article on expedited partner therapy, which is when the partner of someone who's positive for an STD gets a prescription/treatment for the STD without clinical assessment (e.g. your boyfriend gets treated for chlamydia if you test positive, without testing him.) I can't access the article, but the intro says that the CDC recommends EPT, which may raise some legal concerns. I would love to see a copy of the article if anyone has it.

New Pap test - the SoftPAP - approved by the FDA. This test apparently decreases the number of false negatives given by using the traditional (or ThinPrep?) Pap test. Currently it is recommended that women get a Pap test and an HPV test.

A new study shows that 1/3 of women with one sexual partner contract HPV in a year. So I'm just remembering these numbers offhand, but I recall that over 26 million American women have HPV, and only 10,000 cases of cervical cancer are reported per year. Further, only 3,000 women die of cervical cancer. So this mechanism of HPV infection --> cancer is not at all a one-to-one ratio. Anyway, I guess my point is that HPV is really common, and cervical cancer isn't. And while this isn't news to readers, who well know that HPV causes more than just cervical cancer, somehow it's news again that HPV causes oral cancers.

STDs common in Australian Aborigines. The article kind of reminds me of "The Tipping Point" chapter on STDs in as it states that when a population has >10% infection rate it's worth treating everyone with antibiotics to fight infections.

This week was not only MLK Day, but Roe v. Wade Day. Additionally, I lost another family member to cancer. In any case, there was a lot you should have read about:

Roe v. Wade Day/Abortion:Frances Kissling (formerly of CFFC) and Kate Michelman (formerly of NARAL) wrote an op-ed in the LA Times about abortion, and, really, the shift in perception around abortion. They say that one thing the pro-choice folks need to engage in is a discussion about the "challenges" of the movement, including the judgment of women for getting pregnant in the first place.

Saletan says that pro-choicers need to message abortion with the goal of zero, same as teen pregnancy.

Reproducing:Related to the LA Times op-ed, a study out about Indiana shows that about 80% of black babies are born to unwed mothers. Single mothers have lower levels of education and higher rates of poverty than married mothers, although that doesn't necessarily include those older single moms.

Italy has ruled that it is now legal to do pre-implantation genetic diagnosis of embryos. The ruling, applicable only to the Rome area, will be reviewed by a higher court. Also, don't forget, that in Italy only 3 embryos can be implanted at a time.

So while feminism opened up options for a lot of women, there was an ensuing backlash against feminism, and now there's this embrace of everything under the sun as feminism. Want to walk around with a dog collar being led by your boyfriend? Who's to say that's not feminist? Stripping? Feminist. Housewife? Totally feminist (not by all). I'm not about to make any statements about it right now, but it certainly seems to be a trend that the idea of "choice" whether related to feminism or abortion, is in the eye of the beholder. I mean, is one's choice really off bounds for social comment?

Science:The Pill has an extended effect on preventing ovarian cancer, the number one cause of gynecologic cancer deaths in the United States. Apparently, this is leading folks in the U.K. to renew a call to make the Pill available over-the-counter. Additionally, caffeine decreases the risk of ovarian cancer, while alcohol and tobacco use play no role in it.

As always, there's way more to blog about, but I have to get moving. Have a great weekend!

The papers are all abuzz with the recently-released study showing that abortion is down in the United States - at the lowest rate since abortion was Constitutionally protected. Since 1990, surgical abortions are down 25%. The decline in abortion could be positive (more access to contraception, fewer unplanned pregnancies) or negative (less access to abortion, less access to contraceptives) and part of it could be a substitute to RU-486 - we really don't know what's causing the decline. Read the full report (.pdf).

However, we do know that the US has higher fertility rates than other Western countries, due to "a decline in contraceptive use, a drop in access to abortion, poor education and poverty."

In other countries, the stigma of abortions, even legal ones, has led to a rise in illegal abortions, which, as you all know, are not safe. Both medical staff and patients feel this societal sting, and don't want to take part in it.
"It is poor women who cannot countenance another mouth to feed." The women who have the lowest access to medical care and education are the ones hardest hit by the criminalization of abortion.